I am thankful for the words of many former patients

On this Thanksgiving day 2013, I have been reflecting on my time spent in both the United States and Canada working as a physical therapist. Not only have I been thinking about the differences in the way the two countries celebrate the holiday but I have taken some time to think about the patients who helped shape my life and way of thinking. I am thankful for the many patients who had the courage and the honesty to share with me some of the most important lessons they learned in their own lives. In some cases these pearls of wisdom were shared with me by people at the end of their life and in other cases it was people who had just undergone massive change. As a tribute to the most important lessons my former patients have taught me I have taken this Thanksgiving day to write some of them down.

1) The patient in a Vancouver Hospital:

This patient was a woman in her mid 40s. She had a husband and two kids. I was a young student doing a practicum on an acute neurological ward. Her diagnosis was a stage 4 astrocytoma (terminal brain cancer). My job was to improve my patient’s fitness so she could go home to die with her family. After the first two minutes with my patient it became clear that improving her fitness to be able to walk a short flight of steps into her home was not going to happen. When I looked in her eyes, they bounced back and forth rapidly. The tumor was pressing on nerves controlling, amoung other things, her eye movements. She could not open her eyes without severe nausea and vomiting. Moving her from lying down to sitting up caused the same reaction. Despite orders from the physician and nursing staff to “mobilize the patient”, I decided the most therapeutic thing I could do was to advocate for her going home to be with her family. I saw this patient only four or five times before she finally was discharged to go home and die surrounded by her family. During those visits we would talk. We talked about the importance of family. At that time I was young, unmarried, and had no children and no notions of changing my status.

THE LESSON: During one of our last visits she said to me, “If you ever start a family or find love, never pass the opportunity to tell them how much you love them. You never know when your end will come and for me it is too soon. I have to say goodbye to two children under the age of ten. I hope I told them often enough how much I loved them. Say it and mean it as often as you can.”

2) The patient in Kelowna:

I had recently returned to Canada and had just started a private practice with two friends. Life was busy and loaded with stress. I still did not have any children and neither did my business partners. Since most of my friends also did not have children, I began to develop the DINK (double income no kids) mindset. My life goals centered around business success and travel. I found myself saying things like, “the world is too screwed up to bring children into.” One busy day at the clinic, my ethos on the state of the world was about to be tested. I was evaluating a new patient who happened to be a general practitioner. When I was taking her history she mentioned that her busy practice included the delivery of children. She asked me if I had any children and I quickly replied with my canned answer about the world being “too screwed up.”

THE LESSON: After giving her my well-rehearsed answer, she then said, “If not by consciously raising children to make the future better, what are you doing to make the world less screwed up?” She acknowledged that raising children is no guarantee to making the world a better place but her question really shone a spotlight on my self-centered position of the current state of affairs. At that time, I don’t think I really was doing anything to make the future a better place. Sure, I tried to do my part for the environment but what was I really doing to respect the good fortune I received in my life?

3) The patient in Hawaii:

One of the best things about living in Hawaii is the people. While my time there was too short, the people I met had a tremendous affect on my outlook of family, friends, and community. Hawaiians know how to celebrate life. They love to eat and drink and want to share it all. If possible, Hawaiians would never send their parents to a nursing home. Those who can afford to, build Ohana houses on the property or put suites in the house to look after their parents who in turn look after the kids. Friendships are very important to Hawaiians. Children are taught that their parents’ friends are “aunty” and “uncle”. One of my patients who taught me some valuable lessons about friendships and family was also a co-worker. He had a larger-than-life personality. He loved his family and friends intensely and he always had room for more friends. As a somewhat shy Canadian he was insistent upon me becoming part of his massive circle. Every Friday after work he would have friends, neighbors, and family over to celebrate…well…Friday. Every Friday he was so excited to celebrate that he would back his car into the parking stall so he was pointed in the right direction for the Friday celebration. His energy was infectious and the more I got to know him, the more I was inspired by him. Every Friday he would invite me over to his place after work and I always seemed to have some excuse. I would say to myself, “next Friday, I am going to take him up on his offer.”

THE LESSON: The next Friday never came for my friend. He tragically passed away and left behind a wife and two kids. I still think about him everyday. To remind me to never take friendships for granted and to honor his spirit which I so much admired, I named my son after him.

4) The patient in Colorado:

I was treating a gentleman who was in his late sixties. He was a very fit and vibrant man who had a passion for life I could not understand. I mean I love life but this guy was off the charts passionate about living. He was working his dream job as a national park tour guide and on his days off he would grab his tent and backpack and camp all over the southwest. I was just getting into backpacking so he was an inspiration to me. He taught me all about how to get your gear down as light and small as possible. He cut his toothbrush down to three inches long to save room in his pack. One day I was treating him for chronic hip pain. The pain was on the outside of his hip and seemed to be a bursitis. After a few treatments, the pain was not improving and in fact intensifying. I sent the patient back to his family doctor who ordered a CAT scan. A few days later my always upbeat patient returned and thanked me for sending him back to his doctor. It was discovered that he in fact had bone cancer and his hip was being eaten away from the inside. The most amazing part is that while he had been given a life expectancy of a few weeks, he was still upbeat. I couldn’t understand. I had to ask him why he didn’t seem scared or upset.

THE LESSON: He said that while he was disappointed that he didn’t climb all the fourteeners (peaks in Colorado over 14, 000 feet) he lived his life to the fullest and was ready to die. He said that he had a great life and had no regrets. He looked me square in the eyes and said, “Brett, this will be our last visit and we will likely not see each other ever again. I have enjoyed our time together and I leave you with this one piece of advice: WORRY MUCH LESS.” He went on to say, “Worry is such a wasted emotion and it robs you of the ability to experience true joy. Stop worrying and go enjoy your life.” He died three days later.

5) The patient in Pennsylvania:

I was doing a locum at a rehabilitation center in Hershey. I had a patient who recently suffered a stroke. He was re-learning to walk and he was angry. He had just retired a few months ago and was looking forward to finally doing what he wanted to do with his life. He had been a bus driver for most of his life. He took the job out of necessity to support his young family. Prior to bus driving, he was attending a local college and taking art lessons. He always wanted to be a painter and he dreamed of travelling to Paris to see first hand the works of the masters. When he found out that his girlfriend was pregnant, he quit college and got a job to pay the bills. He raised two kids on his salary and now that they had left home and he had retired, he was ready to devote time to his passion. Three months after retiring, a stroke took away his ability to walk and his ability to use his right hand and right eye. He was, understandably, bitter.

THE LESSON: My patient asked me, “Are you passionate about what you are doing?” He also asked, “Is there something you want to do but are putting it off?” I suppose my answers were vague enough for him to say, “Brett, do not live a life where you put off your dreams for another day. That day may never come and life is just too damn short.”

I have a lot to be thankful for. I have a loving partner, a big blended family, I have all the necessities of life. I have encountered many patients over the years like the ones described above. Because of these people I have come into contact with, I can say that I: recognize the importance of friends and family, realize how short life is, understand my role in making the world a better place, and pursue the life I want to live. I still worry too much but l am working on that one.

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